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		<title>医院</title>
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					bgcolor="#F6F9FB" class="bgxz_zhong_bk">

				</td>
				<td width="11" align="left" valign="top">
					&nbsp;
				</td>
				<td width="567" align="left" valign="top" class="bk">
				<!-- 表单填写 -->
				<html:form action="/tc?method=showTc" method="post">
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						style="margin-bottom: 20px">

						<tr>
							<table width="100%" bgcolor="#cccccc">
								<tr>
									<td rowspan="100">
										&nbsp;&nbsp;&nbsp;&nbsp;
									</td>
									<td class="title" width="130px">
										健康题查表&nbsp;&nbsp;
									</td>
								</tr>
								<tr>
									<td class="zi_title" valign="top">
										时间&nbsp;&nbsp;
									</td>
									<td>
										<br />
										体查时间
										 
										<html:text property="jb.tctime" />
										<br />
										体查医院
										<html:text property="jb.tcyiyuan" />
										<br />
										体查医生
										<html:text property="jb.tcyisheng" />
									</td>
								</tr>
								<tr>
									<td class="zi_title" valign="top">
										主诉 &nbsp;
									</td>
									<td>
										<br />
										<html:textarea cols="30" rows="3" property="jb.tczhusu" />
									</td>
								</tr>
								<tr>
									<td class="title" rowspan="2" valign="top">
										一般情况 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br />
										身高
										<html:text size="2" maxlength="3" property="jb.tcshengao" />
										cm
										<br />
										体重
										<html:text size="2" maxlength="3" property="jb.tctizhong" />
										kg/m2
										<br />
										体温
										<html:text size="2" maxlength="3" property="jb.tctiwen" />
										度
										<br />
										脉搏
										<html:text size="2" maxlength="3" property="jb.tcmaibo" />
										次/分
										<br />
										呼吸
										<html:text size="2" maxlength="3" property="jb.tchuxi" />
										次/分
										<br />
										BMI
										&nbsp;
										<html:text size="2" maxlength="3" property="jb.tcBMI" />
										kgm2
										<br />
										腰围
										<html:text size="2" maxlength="3" property="jb.tcyaowei" />
										cm
										<br />
										血压&nbsp;&nbsp;&nbsp;右侧：
										<html:text size="2" maxlength="3" property="jb.tcxueya_y" />
										mmhg &nbsp;&nbsp;左侧：
										<html:text size="2" maxlength="3" property="jb.tcxueya_z" />
										mmhg
										<br />
										认知功能
										<html:text size="60" property="jb.tcrenzi" />
										<br />
										情感状态
										<html:text size="60" property="jb.tcqinggan" />
										<br />
										生活质量
										<html:text size="60" property="jb.tcqinggan"/>
									</td>
								</tr>
								<tr>
									<td class="title" valign="top">
										查体&nbsp;&nbsp;
									</td>
								</tr>
								<tr>
									<td class="title" valign="top">
										头颈部&nbsp;&nbsp;
									</td>
											</tr>
								<tr>
									<td class="zi_title" rowspan="2" valign="top">
										眼科&nbsp;&nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br />
										视力 &nbsp;&nbsp; 左眼:
										<html:text size="2" property="bw.sl_z"  maxlength="3" />
										&nbsp;右眼:
										<html:text size="2" maxlength="3" property="bw.sl_y" />
										&nbsp;&nbsp; 矫正视力&nbsp;左眼:
										<html:text size="2" maxlength="3" property="bw.jzsl_z" />
										&nbsp;右眼:
										<html:text size="2" maxlength="3" property="bw.jzsl_y" />
										<br /> 
										色觉 &nbsp;&nbsp;&nbsp; 
										<html:text  property="bw.sejue" />
										<br /> 
										其他异常&nbsp;
										<html:text  property="bw.qt_yc" />
									</td>
								</tr>
								<tr>
									<td class="title">
										耳鼻喉科 &nbsp;
									</td>
								</tr>
								<tr>
									<td class="zi_title" rowspan="2" valign="top">
										耳 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br />
										听力 
										&nbsp;听不清或无法听见
										<input type="radio"  property="bw.er_tl" />
										<br /> 
										外耳 &nbsp; 
										<html:text  property="bw.er_we" />
									</td>
								</tr>
								<tr>
									<td class="zi_title" rowspan="2" valign="top">
										鼻 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br /> 
										结构 &nbsp; 
										<html:text  property="bw.bi_jg" />
										<br /> 
										鼻窦&nbsp;&nbsp;&nbsp; <html:text  property="bw.bi_bd" />
										<br /> 
										嗅觉 &nbsp; 
										<html:text  property="bw.bi_xj" />
									</td>
								</tr>
								<tr>
									<td class="zi_title" rowspan="3" valign="top">
										咽 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
										<html:text  property="bw.yan" />
									</td>
								</tr>
								<tr>
									<td>
										其他
										&nbsp;&nbsp;<html:text  property="bw.qt_syc"/>
									</td>
								</tr>
								<tr>
									<td class="title" rowspan="2" valign="top">
										口腔科 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br /> 
										&nbsp;&nbsp;&nbsp;&nbsp;唇&nbsp;&nbsp; 
										<html:text  property="bw.kq_cun" />
										<br /> 
										粘膜&nbsp;&nbsp; 
										<html:text  property="bw.kq_nm" />
										<br /> 
										牙齿&nbsp;&nbsp; 
										<html:text  property="bw.kq_yc" />
										<br /> 
										牙龈&nbsp;&nbsp; 
										<html:text  property="bw.kq_yy" />
										<br /> 
										其他&nbsp;&nbsp; 
										<html:text  property="bw.kq_qt" />
									</td>
								</tr>
								<tr>
									<td valign="top" class="title">
										胸腹部 &nbsp;
									</td>
								</tr>
								<tr>
									<td valign="top" class="zi_title" rowspan="2">
										胸部 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br /> 
										胸廓 &nbsp; 
										<html:text  property="bw.xb_xk" />
										<br /> 
										吸音 &nbsp; 
										<html:text  property="bw.xb_hxy" />
										<br />
										啰音 &nbsp;正常
										 
										
										<html:radio  property="bw.xb_ly" value="1"/>
										&nbsp;异常
										<html:radio  property="bw.xb_ly" value="2"/>
										干啰音
										<html:radio  property="bw.xb_ly" value="3"/>
										湿啰音
										<html:radio  property="bw.xb_ly" value="4"/>
										<br />
								<tr>
									<td valign="top" rowspan="2" class="zi_title">
										心脏 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br />
										心率 &nbsp;
										<html:text  size="3" maxlength="3" property="bw.xz_xl" />
										次/分钟
										<br />
										心律 &nbsp; 齐
										<html:radio  property="bw.xz_xlv" value="1"/>
										不齐
										<html:radio  property="bw.xz_xlv" value="2"/>
										绝对不齐
										<html:radio  property="bw.xz_xlv" value="3"/>
										
										<br /> 
										杂音 &nbsp;&nbsp; 
										<html:text  property="bw.xz_zy" />
										<br />
								<tr>
									<td class="zi_title" valign="top" rowspan="2">
										腹部 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br />
										视诊 &nbsp;&nbsp;肠鸣音
										<html:text  property="bw.fb_sz" />
										<br />
										听诊 &nbsp; 压痛 无
										<html:radio  property="bw.fb_tz" value="1"/>
										有&nbsp;&nbsp;
										<html:radio  property="bw.fb_tz" value="2"/>
										<br />
										触诊 &nbsp; 包块 无
										<html:radio  property="bw.fb_cz" value="1"/>
										有&nbsp;&nbsp;
										<html:radio  property="bw.fb_cz" value="2"/>
										<br />
										肝脏 &nbsp; 未触及&nbsp;
										<html:radio  property="bw.fb_gz" value="1"/>
										触及
										<html:radio  property="bw.fb_gz" value="2"/>
										<br />
										脾脏 &nbsp; 未触及&nbsp;
										<html:radio  property="bw.fb_pz" value="1"/>
										触及
										<html:radio  property="bw.fb_pz" value="2"/>
										<br />
										叩诊 &nbsp; 双肾叩击痛 无
										<html:radio  property="bw.fb_kz_yd" value="1"/>
										有
										<html:radio  property="bw.fb_kz_yd" value="2"/>
										<br />
										&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 移动性浊音 无
										<html:radio  property="bw.fb_kz_ss" value="1"/>
										有
										<html:radio  property="bw.fb_kz_ss" value="2"/>
									</td>
								</tr>
								<tr>
									<td class="title" valign="top" rowspan="2">
										其它 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br /> 
										&nbsp; &nbsp; 巩膜 &nbsp; 
										<html:text  property="bw.ph_gm" />
										<br /> 
										甲状腺 &nbsp; 
										<html:text  property="bw.ph_jzx" />
										<br /> 
										&nbsp; &nbsp; 乳房 &nbsp; 
										<html:text  property="bw.ph_rf" />
										<br /> 
										淋巴结 &nbsp; 
										<html:text  property="bw.ph_lbj"/>
									</td>
								</tr>
								<tr>
									<td class="title" valign="top" rowspan="2">
										运动关节 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br />
										运动功能 &nbsp;可以顺利完成
										<html:radio  property="bw.yd_gn" value="1"/>
										无法独立完成
										<html:radio  property="bw.yd_gn" value="2"/>
										<br /> 
										四肢关节 &nbsp; 
										<html:text  property="bw.yd_sz" />
										<br /> 
										&nbsp; &nbsp; &nbsp; &nbsp; 脊柱 &nbsp; 
										<html:text  property="bw.yd_jz" />
										<br /> 
										&nbsp; &nbsp; 前列腺&nbsp; &nbsp; 
										<html:text  property="bw.yd_qlx" />
										<br />
										肛门指珍 &nbsp;
										触痛
										<html:radio  property="bw.yd_gm_ct" value="1"/>
										包块
										<html:radio  property="bw.yd_gm_bk"  value="1" />
										<br />
										&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;其它
										<html:text  property="bw.yd_gm_qt" />
										<br />
										下肢水肿 
										&nbsp; 单侧 右
										<html:radio  property="bw.yd_xz_y" value="1"/>
										左
										<html:radio  property="bw.yd_xz_z" value="1"/>
										<br />
										双侧对称
										<html:radio  property="bw.yd_xz_sc_y" value="1"/>
										双侧不对称
										<html:radio  property="bw.yd_xz_sc_n" value="1"/>
										<br />
									</td>
								</tr>
								<tr>
									<td class="title" valign="top" rowspan="2">
										妇科 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<BR /> 
										月经 &nbsp; 
										<html:text  property="bw.fk_yj" />
										<br /> 
										外阴 &nbsp; 
										<html:text property="bw.fk_wy"  />
										<br /> 
										阴道 &nbsp; 
										<html:text  property="bw.fk_yd" />
										<br /> 
										宫颈 &nbsp; 
										<html:text  property="bw.fk_gj" />
										<br /> 
										子宫 &nbsp; 
										<html:text  property="bw.fk_zg" />
										<br /> 
										附件 &nbsp; 
										<html:text  property="bw.fk_fj" />
										<br /> 
										其它 &nbsp; 
										<html:text  property="bw.fk_qt" />
										<br />
									</td>
								</tr>
								<tr>
									<td>
								<tr>
									<td class="title" valign="top" rowspan="2">
										实验室检查 &nbsp;
									</td>
								</tr>
								<tr>
									<td>
										<br />
										<table>
											<tr>
												<td width="60">
													&nbsp;&nbsp;&nbsp;&nbsp;血糖
												</td>
												<td>
													&nbsp;
													<html:text  size="3" maxlength="3" property="sysjc.xt_ds"/>
													mmol/L&lt;空腹
													<html:radio property="sysjc.xt_zt" value="1" />
													随机
													<html:radio property="sysjc.xt_zt" value="2" />
													&gt;
												</td>
											</tr>
											<tr>
												<td valign="top">
													血常规
												</td>
												<td>
													RBC &nbsp;
													<html:text  size="3" maxlength="3" property="sysjc.xcg_RBC" />
													/L &nbsp;&nbsp;&nbsp;HB &nbsp;
													<html:text  size="3" maxlength="3" property="sysjc.xcg_HB" />
													g/L &nbsp;&nbsp;WBC
													<html:text size="3" maxlength="3" property="sysjc.xcg_WBC" />
													/L &nbsp;PLT&nbsp;&nbsp;
													<html:text  size="3" maxlength="3" property="sysjc.xcg_PLT" />
													/L
												</td>
											</tr>
											<tr>
												<td valign="top">
													尿常规
												</td>
												<td>
													&nbsp;外观
													<html:text size="3" maxlength="3" property="sysjc.ncg_wg" />
													&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;PH &nbsp;&nbsp;
													<html:text  size="3" maxlength="3" property="sysjc.ncg_PH" />
													&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;比重
													<html:text  size="3" maxlength="3" property="sysjc.ncg_bz" />
													<br />&nbsp;尿蛋白
													<html:text  size="3" maxlength="3" property="sysjc.ncg_ndb" />
													<br />
													&nbsp;尿糖&nbsp;&nbsp; &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;酮体
													<html:text  size="3" maxlength="3" property="sysjc.ncg_nt_tt" />
													&nbsp;&nbsp;尿胆红素
													<html:text  size="3" maxlength="3" property="sysjc.ncg_nt_ndhs" />
													<br />&nbsp;尿胆原
													<html:text  size="3" maxlength="3" property="sysjc.ncg_nt_ndy" />
													<br />
													&nbsp;细胞&nbsp;&nbsp; &nbsp;&nbsp;RBC
													<html:text  size="3" maxlength="3" property="sysjc.ncg_xb_RBC" />
													&nbsp;&nbsp;WBC
													<html:text  size="3" maxlength="3" property="sysjc.ncg_xb_WBC" />
													&nbsp;&nbsp;上皮细胞
													<html:text  size="3" maxlength="3" property="sysjc.ncg_xb_spxb" />
													&nbsp;管型
													<html:text  size="3" maxlength="3" property="sysjc.ncg_xb_gx" />													
													&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;结晶体
													<html:text  size="3" maxlength="3" property="sysjc.ncg_xb_jjt" />
													&nbsp;&nbsp;其他
													<html:text  size="3" maxlength="3" property="sysjc.ncg_qt" />
												</td>
											</tr>
											<tr>
												<td valign="top">
													粪常规
												</td>
												<td>
													粪常规 &nbsp;
													<html:text  size="3" maxlength="3" property="sysjc.fcg_fcg" />
													&nbsp;&nbsp; 虫卵 &nbsp;
													<html:text  size="3" maxlength="3" property="sysjc.fcg_cl" />
													<br />
													&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
													&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
													隐血试验&nbsp;&nbsp;1阴性
													<html:radio  property="sysjc.fcg_yxsy_ying" value="1"/>
													&nbsp;&nbsp;2阳性
													<html:radio  property="sysjc.fcg_yxsy_yang" value="1"/>
												</td>
											</tr>
											
											<tr>
												<td valign="top">
													肝功能
												</td>
												<td>
													&nbsp;ALT &nbsp;
													<html:text  size="3" maxlength="3" property="gn.alt" />
													u/L &nbsp; &nbsp; &nbsp; &nbsp;&nbsp; AST
													<html:text  size="3" maxlength="3" property="gn.ast" />
													u/L &nbsp; &nbsp; &nbsp;ALB
													<html:text  size="3" maxlength="3" property="gn.alb" />
													g/L
													<br />
													&nbsp;TBIL&nbsp;
													<html:text  size="3" maxlength="3" property="gn.tbil" />
													umol/L &nbsp;&nbsp;DBIL
													<html:text  size="3" maxlength="3" property="gn.dbil" />
													umol/L
												</td>
											</tr>
											<tr>
												<td valign="top">
													肾功能
												</td>
												<td>
													&nbsp; &nbsp;&nbsp;Scr
													<html:text  size="3" maxlength="3" property="gn.scr" />
													umol/L &nbsp; &nbsp;BUN
													<html:text  size="3" maxlength="3" property="gn.bun" />
													umol/L &nbsp;&nbsp;UA
													<html:text  size="3" maxlength="3" property="gn.ua" />
													umol/L
												</td>
											</tr>
											<tr>
												<td>
													血脂
												</td>
												<td>
													&nbsp;CHO
													<html:text  size="3" maxlength="3" property="gn.cho" />
													umol/L &nbsp; &nbsp; &nbsp;TG
													<html:text  size="3" maxlength="3" property="gn.tg" />
													umol/L &nbsp;&nbsp;LDL-C
													<html:text  size="3"  property="gn.ldl_c" />
													umol/L
												</td>
											</tr>
											<tr>
												<td>
													凝血功能
												</td>
												<td>
													BT
													<html:text  size="3" maxlength="3" property="gn.bt" />
													&nbsp;&nbsp; PC
													<html:text  size="3" maxlength="3" property="gn.pc"/>
													&nbsp;&nbsp; APTT
													<html:text  size="3"  property="gn.aptt" />
													&nbsp;&nbsp; PT
													<html:text  size="3" maxlength="3" property="gn.pt"/>
												</td>
											</tr>
											<tr>
												<td>
													HBsAg
												</td>
												<td>
													阴性
													<html:radio  property="gn.HBsAg" value="1" />
													&nbsp;&nbsp; 阳性
													<html:radio  property="gn.HBsAg" value="2"/>
												</td>
											</tr>
											<tr>
												<td>
													HBsAb
												</td>
												<td>
													阴性
													<html:radio  property="gn.HBsAb" value="1" />
													&nbsp;&nbsp; 阳性
													<html:radio  property="gn.HBsAb" value="2"/>
												</td>
											</tr>
											<tr>
												<td>
													心电图
												</td>
												<td><html:text  property="gn.xdt" />
												</td>
											</tr>
											<tr>
												<td>
													胸部X线检查
												</td>
												<td>&nbsp;<html:text  property="gn.xbXx" />
												</td>
											</tr>
											<tr>
												<td valign="top">
													B超
												</td>
												<td>
													肝&nbsp;胆&nbsp;胰&nbsp;脾&nbsp;&nbsp;B超检查
													<html:text  property="gn.gdBc" />
													<br />
													双肾&nbsp;膀胱&nbsp;&nbsp;&nbsp;&nbsp;B超检查
													<html:text  property="gn.ssBc" />
													<br />
													前列腺&nbsp;子宫附件&nbsp;&nbsp;B超检查
													<html:text  property="gn.qlxBc" />
												</td>
											</tr>
											<tr>
												<td>
													其他
												</td>
												<td>
													<html:text  size='30'  property="gn.others" />
												</td>
											</tr>
										</table>
								<tr>
									<td valign="top" class="title">
										特殊人群 &nbsp;
									</td>
								</tr>
								<tr>
									<td valign="top" class="zi_title">
										检查
									</td>
								</tr>
								<tr>
									<td valign="top" class="zi_title">
										糖尿病
									</td>
									<td>
										足背动脉搏动 &nbsp; &nbsp;明显
										<html:radio  property="zz.zbdm" value="1"/>
										&nbsp;&nbsp;不明显
										<html:radio  property="zz.zbdm" value="2"/>
										<br />
										糖化血红蛋白&nbsp;&nbsp;
										<html:text  size='3' property="zz.thxhdb" />
										%
									</td>
								</tr>
								<tr>
									<td valign="top" class="zi_title">
										高血压
									</td>
									<td>
										血生化K&nbsp;&nbsp;
										<html:text  size='3' property="zz.xshK" />
										Na
									</td>
								</tr>
								<tr>
									<td valign="top" class="zi_title">
										COPD症状
									</td>
									<td>
										<table>
											<tr>
												<td width='60' valign="top">
													咳嗽
												</td>
												<td>
													0分
													<html:radio  property="zz.COPDks" value="0"/>
													无咳嗽
													<br />
													1分
													<html:radio  property="zz.COPDks" value="1"/>
													轻度&lt间断咳嗽不影响正常工作和生活&gt
													<br />
													2分
													<html:radio  property="zz.COPDks" value="2"/>
													中度&lt介于轻度跟重度之间&gt
													<br />
													3分
													<html:radio  property="zz.COPDks" value="3"/>
													重度 &lt昼夜频繁咳嗽或连续咳嗽影响工作和睡眠&gt
												</td>
											</tr>
											<tr>
												<td valign="top">
													咯痰
												</td>
												<td>
													0分
													<html:radio  property="zz.COPDkt" value="0"/>
													无痰
													<br />
													1分
													<html:radio  property="zz.COPDkt" value="1"/>
													少&lt昼夜咯痰量&lt 10ML&gt
													<br />
													2分
													<html:radio  property="zz.COPDkt" value="2"/>
													中&lt昼夜咯痰量10ML-50ML&gt
													<br />
													3分
													<html:radio  property="zz.COPDkt" value="3"/>
													多&lt昼夜咯痰量&gt 50ML&gt
												</td>
											</tr>
											<tr>
												<td valign="top">
													呼吸困难
												</td>
												<td>
													0分
													<html:radio property="zz.COPDhxkn" value="0" />
													剧烈运动《如跑步》时感气短
													<br />
													1分
													<html:radio  property="zz.COPDhxkn" value="1"/>
													快步走或上楼时感气短
													<br />
													2分
													<html:radio  property="zz.COPDhxkn" value="2"/>
													平地正常速度行走100米感气短
													<br />
													3分
													<html:radio  property="zz.COPDhxkn" value="3"/>
													日常活动《穿衣，起床》感气短
													<br />
													4分
													<html:radio  property="zz.COPDhxkn" value="4"/>
													静息状态下感气短
												</td>
											</tr>
											<tr>
												<td valign="top">
													哮鸣音
												</td>
												<td>
													0分
													<html:radio  property="zz.COPDxny" value="0"/>
													无哮鸣音
													<br />
													1分
													<html:radio  property="zz.COPDxny"  value="1"/>
													少 &lt偶尔或仅在咳嗽，深呼吸时闻少量哮鸣音&gt
													<br />
													2分
													<html:radio  property="zz.COPDxny" value="2"/>
													中 &lt双肺可闻散在哮鸣音&gt
													<br />
													3分
													<html:radio  property="zz.COPDxny"  value="3"/>
													多 &lt双肺布满哮鸣音&gt
												</td>
											</tr>
											<tr>
												<td>
													口唇紫绀
												</td>
												<td>
													无
													<html:radio  property="zz.COPDkc" value="1"/>
													&nbsp; 有
													<html:radio  property="zz.COPDkc" value="2"/>
												</td>
											</tr>
											<tr>
												<td>
													颈静脉
												</td>
												<td>
													正常
													<html:radio  property="zz.COPDjjm" value="1"/>
													&nbsp; 怒张
													<html:radio  property="zz.COPDjjm" value="2"/>
												</td>
											</tr>
										</table>
									</td>
								</tr>
								<tr>
									<td valign="top" class="zi_title">
										其他
									</td>
									<td>
										6分钟步行距离
										&nbsp;&nbsp;&nbsp;
										<html:text  property="zz.bxm" />
										米
										<br />
										血氧饱和度SA02
										&nbsp;
										<html:text  property="zz.xybhd" />
										%
										<br />
										肺功能&nbsp;FEVI/FVC
										<html:text  property="zz.ggnfevi" />
										%<br />&nbsp;&nbsp; FEVI
										&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
										&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
										<html:text  property="zz.fevi" />
										%
										<br />
										COPD患者生活质量
										<html:text  size='30' property="zz.copd"/>
										<br />
										SGRQ评分
										<html:text  size='30' property="zz.sgrq" />
										<br />
									</td>
								</tr>
								<tr>
									<td valign="top" class="title">
										现存健康问题 &nbsp;
									</td>
								</tr>
								<tr>
									<td colspan='2'>
										<table>
											<tr>
												<td rowspan='10'>
													&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;
													&nbsp; &nbsp; &nbsp;
												</td>
												<td valign="top" class="zi_title">
													脑血管疾病
												</td>
												<td>
													缺血性cccu中
													<html:radio property="xc.cccu" value="1" />
													&nbsp;&nbsp; 脑出血
													<html:radio  property="xc.ncx" value="1"/>
													&nbsp;&nbsp; 蛛网膜下腔出血
													<html:radio property="xc.zwmcx" value="1" />
													<br />
													短暂性脑缺血发作
													<html:radio  property="xc.dznqx" value="1"/>
													&nbsp;&nbsp; <br />其他
													<html:text  size='20' property="xc.nxgothers" value="1" />
												</td>
											</tr>
											<tr>
												<td valign="top" class="zi_title">
													心脏疾病
												</td>
												<td>
													充血性心力衰竭
													<html:radio  property="xc.xlsj" value="1"/>
													&nbsp;&nbsp; 冠状动脉血运重建
													<html:radio  property="xc.gzdmcj" value="1"/>
													<br />
													心肌梗塞
													<html:radio  property="xc.xjgs" value="1"/>
													&nbsp;&nbsp; 心绞痛
													<html:radio  property="xc.xjt" value="1"/>
													&nbsp;&nbsp; 心前区疼痛
													<html:radio  property="xc.xqqtt" value="1"/>
													<br />其他
													<html:text  size='20' property="xc.xxgothers"  />
												</td>
											</tr>
											<tr>
												<td valign="top" class="zi_title">
													血管疾病
												</td>
												<td>
													夹层动脉瘤
													<html:radio  property="xc.jcdml" value="1"/>
													&nbsp;&nbsp; 动脉闭塞性疾病
													<html:radio  property="xc.dmbs" value="1"/>
													&nbsp;&nbsp; <br />其他
													<html:text  size='20' property="xc.xgothers"/>
												</td>
											</tr>
											<tr>
												<td valign="top" class="zi_title">
													消化系统疾病
												</td>
												<td>
													胃十二指肠溃疡
													<html:radio  property="xc.sejcky" value="1"/>
													&nbsp;&nbsp; 返流性食管炎
													<html:radio  property="xc.flxsgy" value="1"/>
													&nbsp;&nbsp; 慢性胃炎
													<html:radio  property="xc.mxwy" value="1"/>
													<br />
													溃疡性结肠炎
													<html:radio  property="xc.kyxjcy" value="1"/>
													&nbsp;&nbsp; 肝炎
													<html:radio  property="xc.gy" value="1"/>
													&nbsp;&nbsp; 脂肪炎
													<html:radio  property="xc.zfy" value="1"/>
													<br />
													高脂血症
													<html:radio  property="xc.gzxz" value="1"/>
													&nbsp;&nbsp; 胆石症
													<html:radio  property="xc.dsz" value="1"/>
													&nbsp;&nbsp; 胆囊炎
													<html:radio  property="xc.dny" value="1"/>
													<br />
													其他
													<html:text  size='50' property="xc.xhxtothers" />
												</td>
											</tr>
											<tr>
												<td valign="top" class="zi_title">
													呼吸系统疾病
												</td>
												<td>
													COPD
													<html:radio  property="xc.copd" value="1"/>
													&nbsp;&nbsp; 肺炎
													<html:radio  property="xc.fy" value="1"/>
													&nbsp;支气管炎
													<html:radio  property="xc.zqgy" value="1"/>
													&nbsp;支气管哮喘
													<html:radio  property="xc.zqgxc" value="1"/>
													<br />
													肺结核
													<html:radio  property="xc.fjh" value="$1"/>
													&nbsp;&nbsp; 其他
													<html:text  size='30' property="xc.hxothers" />
												</td>
											</tr>
											<tr>
												<td valign="top" class="zi_title">
													肾脏疾病
												</td>
												<td>
													糖尿病肾病
													<html:radio  property="xc.tnbsb" value="1"/>
													&nbsp;&nbsp; 肾功能衰竭
													<html:radio property="xc.sgnsj" value="1" />
													&nbsp;&nbsp; 急性肾炎
													<html:radio  property="xc.jxsy" value="1"/>
													<br />
													慢性肾炎
													<html:radio  property="xc.mxsy" value="1"/>
													&nbsp;&nbsp; 泌尿系统结石
													<html:radio property="xc.mlxtjs" value="1" />
													&nbsp;&nbsp; <br />其他
													<html:text  size='15' property="xc.szothers"/>
												</td>
											</tr>
											<tr>
												<td valign="top" class="zi_title">
													眼部疾病
												</td>
												<td>
													屈光不正
													<html:radio  property="xc.qgbz" value="1"/>
													&nbsp;&nbsp; 结膜炎
													<html:radio  property="xc.jmy" value="1"/>
													&nbsp;&nbsp; 白内障
													<html:radio  property="xc.bnz" value="1"/>
													&nbsp;&nbsp; 青光眼
													<html:radio property="xc.qgy" value="1" />
													<br />
													黄斑部变性
													<html:radio  property="xc.hbbbx" value="1"/>
													&nbsp;&nbsp; 视网膜动脉硬化
													<html:radio property="xc.swmdmyh" value="1" />
													&nbsp;&nbsp; <br />其他
													<html:text  size='15' property="xc.ybothers" />
												</td>
											</tr>
											<tr>
												<td valign="top" class="zi_title">
													神经系统疾病
												</td>
												<td>&nbsp;&nbsp; 
													<html:text  size='30' property="xc.sjxtjb" />
												</td>
											</tr>
											<tr>
												<td valign="top" class="zi_title">
													其他疾病
												</td>
												<td>&nbsp;&nbsp; 
													<html:text  size='30' property="xc.qtjb" />
												</td>
											</tr>
										</table>
								<tr>
									<td valign="top" class="title">
										住院治疗情况
									</td>
								</tr>
								<tr>
									<td colspan='2'>
								<tr>
									<td valign="top" class="zi_title">
										住院史
									</td>
									<td>
										<table>
											<tr>
												<td>
													入/出院时间
												</td>
												<td>
													<html:text  size='30' property="zy.dtime"/>
												</td>
											</tr>
											<tr>
												<td align='right'>
													原因
												</td>
												<td>
													<html:text  size='30' property="zy.dyuanyin" />
												</td>
											</tr>
											<tr>
												<td>
													医疗机构名称
												</td>
												<td>
													<html:text  size='30' property="zy.jigoumc" />
												</td>
											</tr>
											<tr>
												<td>
													病案号
												</td>
												<td>
													<html:text  size='30' property="zy.bam" />
												</td>
											</tr>
										</table>
								<tr>
									<td valign="top" class="zi_title">
										用药情况
									</td>
									<td>
										服药依从性&nbsp;&nbsp;&nbsp;&nbsp; 规律服药
										<html:radio  property="zy.yyyc" value="1"/>
										&nbsp;&nbsp; 间断服药
										<html:radio  property="zy.yyyc" value="2"/>
										&nbsp;&nbsp; 不服药
										<html:radio  property="zy.yyyc" value="3"/>
										&nbsp;&nbsp;
										<br /> 
										服药名称 
										<html:text  size='30' property="zy.fymingcheng" />
										<br />
									</td>
								</tr>
								<tr>
									<td valign="top" class="title">
										非免疫计划预防接种史
									</td>
									<td>
										<table>
											<tr>
												<td>
													流感疫苗
												</td>
												<td>
													次数
													<html:text  property="zy.lgym"/>
												</td>
											</tr>
											<tr>
												<td>
													肺炎球菌疫苗
												</td>
												<td>
													时间
													<html:text  property="zy.fyqjy"  />
												</td>
											</tr>
											<tr>
												<td>
													狂犬病疫苗
												</td>
												<td>
													时间
													<html:text  size='15' property="zy.kqym"  />
												</td>
											</tr>
											<tr>
												<td>
													蛇类疫苗
												</td>
												<td>
													时间
													<html:text  size='15'property="zy.slym"  />
												</td>
											</tr>
											<tr>
												<td>
													其他疫苗
												</td>
												<td colspan='3'>
													<html:text  size='30' property="zy.ymothers" />
												</td>
											</tr>
										</table>
								</tr>

							</table>
			</tr>
		</table>
</html:form>
		
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